9 ms·

Personally, I think smart people just do this. When I got sick with COVID I cannot begin to describe the number of people who became doctors during this unprece

by kodah 6y ago

Personally, I think smart people just do this. When I got sick with COVID I cannot begin to describe the number of people who became doctors during this unprecedented time, only to send me outdated comments, articles, and speculation. All of these people thought they were smarter than the instruction I received from a real doctor, nurse practitioner, and the CDC. These were smart people, though, and mostly (but not limited to) highly educated engineers.

robntheh00d 6y ago
Sympathetic response is a thing. One has to balance that with awareness they’re talking out their ass.
Tenoke 6y ago
I saw plenty of smart people ahead of institutions and real doctors on masks and to some extents other aspects of the pandemic. Yes, in general if you don't know much on a topic you'd on average do best if you listen to the experts but you can outperform that if you can identify the right kind of smart people with a good track record.
- nemo44x 6y ago
  "Right kind of people" have no accountability to their advice. A doctor can't really just hazard a guess without actual facts to base them in or risk losing their ability to practice and/or reputation. "Right kind of people" can be and are often plenty wrong about things but it fades into obscurity and they are never held accountable. Of course they are right sometimes but on many issues with a binary choice (should or shouldn't wear masks) that's a 50% chance. In the long run you want to be able to discern hearsay, opinion, and rumors from facts and accountability to them. You see it today when inquiring if a pregnant woman should get the vaccine. Doctors won't really advise you because although they maybe feel it's totally safe if you're far enough along, they would be held accountable if something happened. They can be "pretty sure" about things, but that isn't enough. Meanwhile, "very smart person" on Twitter can reference a bunch of content from unaccountable people that says it's safe and come off as an expert when they aren't. It's easy to be "right" when you don't have skin in the game and especially so when no one is going to hold you to account for all the times you were wrong or misinformed.
  - Tenoke 6y ago
    >A doctor can't really just hazard a guess without actual facts to base them in or risk losing their ability to practice and/or reputation. No, but one doctor might base advice on one study he saw another on a different one. Having skin in the game helps but it is also well documented that doctors might be overly cautious due to risk of litigation and thus sometimes chose suboptimal courses of action. >Of course they are right sometimes but on many issues with a binary choice (should or shouldn't wear masks) that's a 50% chance. No, this isn't a real coinflip. There's evidence for and against things like this, and some people have learned better than others how to evaluate such evidence and can definitely do better than 50%.
  - DennisP 6y ago
    Last spring I was briefly lectured by a maskless doctor who said I shouldn't bother with the mask I was wearing at an appointment. I shrugged and kept my mask on. A month or two later I saw him again. He was wearing a mask that time and didn't complain about mine. That doctor didn't just avoid guessing. He gave unsolicited advice, on limited information, that turned out to be exactly wrong and somewhat dangerous.
    - nemo44x 6y ago
      It sounds like that doctor has lost some reputation to you now. It’s hard for people to say “I don’t know” for some reason.
- mcguire 6y ago
  I saw plenty of smart people ahead of institutions and experts on hydroxychloroquine here on HN. They were wrong. Smart people with a good track record are generally called "the experts".
  - Izkata 6y ago
    That is the single most frustrating part of the pandemic for me: * There was preliminary evidence from the experts it might work. * At some point Trump got wind of this and mentioned it. * The media, in an effort to portray Trump as wrong, went on a crazy cherry-picking campaign to show HCQ as completely ineffective. "HCQ does not work" was the prevailing sentiment for almost the entire past year because of this, even though evidence was still coming out it does work under certain circumstances. * Now that Trump is out of office, our understanding of HCQ is shifting back to exactly what that preliminary evidence said that Trump repeated.
    - mcguire 6y ago
      * https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30390-8/fulltext https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9... "They included 30 569 patients with systemic lupus erythematosus or rheumatoid arthritis who were already taking hydroxychloroquine in the 6 months before what was considered as the start of the pandemic in England and 164 068 patients with these rheumatic diseases who did not use hydroxychloroquine. The study found no significant difference in standardised cumulative COVID-19 mortality associated with hydroxychloroquine use (0·23% among hydroxychloroquine users and 0·22% among non-users) with an adjusted hazard ratio of 1·03 (95% CI 0·80–1·33)." * https://www.acc.org/latest-in-cardiology/clinical-trials/2020/12/14/14/28/hydroxychloroquine-covid-19-pep https://www.acc.org/latest-in-cardiology/clinical-trials/202... "Among patients exposed to patients with SARS-CoV-2, hydroxychloroquine, administered within a median duration of 2 days as post-exposure prophylaxis, did not reduce the incidence of SARS-CoV-2 or COVID-19 infection within 14 days, compared with placebo (vitamin C)." * https://www.nih.gov/news-events/nih-research-matters/hydroxychloroquine-doesnt-benefit-hospitalized-covid-19-patients https://www.nih.gov/news-events/nih-research-matters/hydroxy... "Researchers assessed each patient’s condition 14 days after being assigned to a treatment group. They used a seven-category scale ranging from one (death) to seven (discharged from the hospital and able to perform normal activities). The results showed no significant difference between the hydroxychloroquine and placebo groups. The scientists also found no differences in any of 12 additional outcomes, which included mortality 28 days after assignment to a treatment group or time to recovery. Based on the data, they concluded that hydroxychloroquine was not an effective treatment." * https://jamanetwork.com/journals/jama/fullarticle/2772921 https://jamanetwork.com/journals/jama/fullarticle/2772921 "Several published rigorous studies have demonstrated similar findings. In the well-conducted clinical trials published to date, hydroxychloroquine has been evaluated in a wide variety of populations, ranging from patients with severe illness2-4 to individuals at risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, in whom the drug was used as primary prophylaxis5; these studies failed to show any beneficial effect of the drug. This raises the question: How did medicine get to the point where so many studies were conducted assessing the possible benefit of hydroxychloroquine, that led to nearly identical findings, and have been published in major journals?" * https://www.nejm.org/doi/full/10.1056/NEJMoa2022926 https://www.nejm.org/doi/full/10.1056/NEJMoa2022926 "Among patients hospitalized with Covid-19, those who received hydroxychloroquine did not have a lower incidence of death at 28 days than those who received usual care." * https://www.cdc.gov/mmwr/volumes/69/wr/mm6935a4.htm https://www.cdc.gov/mmwr/volumes/69/wr/mm6935a4.htm "New prescriptions by specialists who did not typically prescribe these medications (defined as specialties accounting for ≤2% of new prescriptions before 2020) increased from 1,143 prescriptions in February 2020 to 75,569 in March 2020, an 80-fold increase from March 2019." * https://www.aljazeera.com/economy/2021/1/27/oklahoma-attempts-to-return-2m-worth-of-anti-malaria-drug https://www.aljazeera.com/economy/2021/1/27/oklahoma-attempt... "Oklahoma tries to return $2m worth of hydroxychloroquine" Under what circumstances does it work?
xapata 6y ago
> a real doctor, nurse practitioner, and the CDC Sadly, many doctors and nurses are statistically illiterate. I know, because I (try to) teach them statistics. Remember, the Surgeon General of the CDC said that, "[masks] are NOT effective in preventing general public from catching #Coronavirus," perhaps in some misguided belief that avoiding panicked mask-buying was more important than a mask-wearing public. [Sorry for insulting our healthcare heroes, but ... evidently y'all haven't been responsible for teaching them evidence-based medicine. It ain't easy.]
- iso1631 6y ago
  > The CDC was parroting the anti-mask blather of the Trump administration And the WHO were too?
  - xapata 6y ago
    Sorry, edited after you wrote this. I took out the reference to the Trump administration because it wasn't helpful to the main point of many doctors not being experts on epidemics.
- DanBC 6y ago
  Can you link to the papers that were available in March 2020 that showed that masks are effective? Use any definition of "mask" and "effective" you want, but preferably effective should include some concept of "prevents spread of respiratory disease". Covid is a serious illness. Far too many people have been told, and believe, that they can continue their normal day to day life so long as they put mask on. This is untrue, and this advice has driven mass infection and death.
  - TeMPOraL 6y ago
    This is a pandora's box. My recollection of the events is this: around March 2020, there were some links to somewhat shoddy studies of effectiveness of masks in case of other diseases, but the official statement was that masks were not proven to be effective - but that's because there was no randomized control trial performed to check mask effectiveness against SARS variants, and how could there be? This spins off into a whole discussion of how evidence-based medicine can lead you off the cliff when you follow its letter, and not spirit, because despite something being bloody obvious, there is no RCT proving that.
dmurray 6y ago
To be fair, professional medical advice was especially low-quality in the early days of the pandemic. What was important was public health messaging, picking some lowest-common-denominator messages and having everyone repeat them. It wasn't hard to be better informed than that.
- phkahler 6y ago
  >> To be fair, professional medical advice was especially low-quality in the early days of the pandemic. They primarily suffer from dogma IMHO. For example, now they know people with breathing difficulty should be kept in prone position. I dont know if that applies outside of Covid19, but I thought it was really interesting to see them learn it. Like "oh, what we'd normally do is bad but this variation is good". Medicine also suffers from a fear (justified) of litigation. If they dont follow accepted practices they may get sued if someone dies. The funny thing with Covid was watching that fear when there was no accepted treatment. Seeing them say "The FDA hasn't approved that for covid" when they hadn't approved anything at all yet.
  - PaulDavisThe1st 6y ago
    > Medicine also suffers from a fear (justified) of litigation. very US-centric. Medical litigation in many others parts of the world doesn't work in the same way, and isn't a driving force in the way medicine is practiced.
hrktb 6y ago
I agree in principle. Then in real life example you will have real doctors and nurses giving conflicting advices and having wildly different viewpoints on the details. The easy to point to example is how a lot of doctors viewed masks at the beginning of the pandemic. Or how trickle down economics is also endorsed by experts. Or experts opinions on mental health drugs. And so many other subjects where it won’t be hard to find an expert on the dumb side of the argument. I think we should rely on experts, but we can’t dismiss people’s doubts or research just with a “I’ve seen a real doctor” slight of hand.
- hef19898 6y ago
  Conflicting doesn't mean that one, or both, opinions are wrong. There is more than solution to every problem.
- scythe 6y ago
  >Or how trickle down economics is also endorsed by experts. Trickle-down economics is not explicitly endorsed by anyone, because it's a pejorative. That's like saying "totalitarianism is popular in some countries"; you might think those countries are totalitarian, but they don't.
  - PaulDavisThe1st 6y ago
    > you might think those countries are totalitarian, but they don't. "You" in the above is a specific individual. "They" in the above is undefined and extremely imprecise. For various definitions of "they", your statement could be true, false or somewhere in between.
  - mjburgess 6y ago
    Indeed. Even then, as a term, it refers to a specific regan-era tax policy. What many on the left assume it means, is a sincere description of growth "raising the tide"; and how ridiculous an idea that is. Of course the tide has risen to an unprecedented degree in human history both since the term "trickle down" was invented; and moreso, over the last 40 years.
tacitusarc 6y ago
I absolutely agree with the main thrust of your comment, but I want to point out that in unprecedented times specifically, the odds that a smart non-expert is more correct than an expert are substantially higher than in normal times.
- mcguire 6y ago
  ... but still not particularly high.
mcguire 6y ago
Engineers, in particular, have a reputation for being experts on everything.
- glitchc 6y ago
  perceived :D
  - lioeters 6y ago
    I think "self-perceived expert" fits well. "When Knowledge Knows No Bounds: Self-Perceived Expertise Predicts Claims of Impossible Knowledge" - Stav Atir, Emily Rosenzweig, David Dunning https://journals.sagepub.com/doi/abs/10.1177/0956797615588195 https://journals.sagepub.com/doi/abs/10.1177/095679761558819...

by kodah 6y ago

robntheh00d 6y ago

Sympathetic response is a thing. One has to balance that with awareness they’re talking out their ass.

Tenoke 6y ago

I saw plenty of smart people ahead of institutions and real doctors on masks and to some extents other aspects of the pandemic. Yes, in general if you don't know much on a topic you'd on average do best if you listen to the experts but you can outperform that if you can identify the right kind of smart people with a good track record.

nemo44x 6y ago
"Right kind of people" have no accountability to their advice. A doctor can't really just hazard a guess without actual facts to base them in or risk losing their ability to practice and/or reputation. "Right kind of people" can be and are often plenty wrong about things but it fades into obscurity and they are never held accountable. Of course they are right sometimes but on many issues with a binary choice (should or shouldn't wear masks) that's a 50% chance. In the long run you want to be able to discern hearsay, opinion, and rumors from facts and accountability to them. You see it today when inquiring if a pregnant woman should get the vaccine. Doctors won't really advise you because although they maybe feel it's totally safe if you're far enough along, they would be held accountable if something happened. They can be "pretty sure" about things, but that isn't enough. Meanwhile, "very smart person" on Twitter can reference a bunch of content from unaccountable people that says it's safe and come off as an expert when they aren't. It's easy to be "right" when you don't have skin in the game and especially so when no one is going to hold you to account for all the times you were wrong or misinformed.
- Tenoke 6y ago
  >A doctor can't really just hazard a guess without actual facts to base them in or risk losing their ability to practice and/or reputation. No, but one doctor might base advice on one study he saw another on a different one. Having skin in the game helps but it is also well documented that doctors might be overly cautious due to risk of litigation and thus sometimes chose suboptimal courses of action. >Of course they are right sometimes but on many issues with a binary choice (should or shouldn't wear masks) that's a 50% chance. No, this isn't a real coinflip. There's evidence for and against things like this, and some people have learned better than others how to evaluate such evidence and can definitely do better than 50%.
- DennisP 6y ago
  Last spring I was briefly lectured by a maskless doctor who said I shouldn't bother with the mask I was wearing at an appointment. I shrugged and kept my mask on. A month or two later I saw him again. He was wearing a mask that time and didn't complain about mine. That doctor didn't just avoid guessing. He gave unsolicited advice, on limited information, that turned out to be exactly wrong and somewhat dangerous.
  - nemo44x 6y ago
    It sounds like that doctor has lost some reputation to you now. It’s hard for people to say “I don’t know” for some reason.
mcguire 6y ago
I saw plenty of smart people ahead of institutions and experts on hydroxychloroquine here on HN. They were wrong. Smart people with a good track record are generally called "the experts".
- Izkata 6y ago
  That is the single most frustrating part of the pandemic for me: * There was preliminary evidence from the experts it might work. * At some point Trump got wind of this and mentioned it. * The media, in an effort to portray Trump as wrong, went on a crazy cherry-picking campaign to show HCQ as completely ineffective. "HCQ does not work" was the prevailing sentiment for almost the entire past year because of this, even though evidence was still coming out it does work under certain circumstances. * Now that Trump is out of office, our understanding of HCQ is shifting back to exactly what that preliminary evidence said that Trump repeated.
  - mcguire 6y ago
    * https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30390-8/fulltext https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9... "They included 30 569 patients with systemic lupus erythematosus or rheumatoid arthritis who were already taking hydroxychloroquine in the 6 months before what was considered as the start of the pandemic in England and 164 068 patients with these rheumatic diseases who did not use hydroxychloroquine. The study found no significant difference in standardised cumulative COVID-19 mortality associated with hydroxychloroquine use (0·23% among hydroxychloroquine users and 0·22% among non-users) with an adjusted hazard ratio of 1·03 (95% CI 0·80–1·33)." * https://www.acc.org/latest-in-cardiology/clinical-trials/2020/12/14/14/28/hydroxychloroquine-covid-19-pep https://www.acc.org/latest-in-cardiology/clinical-trials/202... "Among patients exposed to patients with SARS-CoV-2, hydroxychloroquine, administered within a median duration of 2 days as post-exposure prophylaxis, did not reduce the incidence of SARS-CoV-2 or COVID-19 infection within 14 days, compared with placebo (vitamin C)." * https://www.nih.gov/news-events/nih-research-matters/hydroxychloroquine-doesnt-benefit-hospitalized-covid-19-patients https://www.nih.gov/news-events/nih-research-matters/hydroxy... "Researchers assessed each patient’s condition 14 days after being assigned to a treatment group. They used a seven-category scale ranging from one (death) to seven (discharged from the hospital and able to perform normal activities). The results showed no significant difference between the hydroxychloroquine and placebo groups. The scientists also found no differences in any of 12 additional outcomes, which included mortality 28 days after assignment to a treatment group or time to recovery. Based on the data, they concluded that hydroxychloroquine was not an effective treatment." * https://jamanetwork.com/journals/jama/fullarticle/2772921 https://jamanetwork.com/journals/jama/fullarticle/2772921 "Several published rigorous studies have demonstrated similar findings. In the well-conducted clinical trials published to date, hydroxychloroquine has been evaluated in a wide variety of populations, ranging from patients with severe illness2-4 to individuals at risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, in whom the drug was used as primary prophylaxis5; these studies failed to show any beneficial effect of the drug. This raises the question: How did medicine get to the point where so many studies were conducted assessing the possible benefit of hydroxychloroquine, that led to nearly identical findings, and have been published in major journals?" * https://www.nejm.org/doi/full/10.1056/NEJMoa2022926 https://www.nejm.org/doi/full/10.1056/NEJMoa2022926 "Among patients hospitalized with Covid-19, those who received hydroxychloroquine did not have a lower incidence of death at 28 days than those who received usual care." * https://www.cdc.gov/mmwr/volumes/69/wr/mm6935a4.htm https://www.cdc.gov/mmwr/volumes/69/wr/mm6935a4.htm "New prescriptions by specialists who did not typically prescribe these medications (defined as specialties accounting for ≤2% of new prescriptions before 2020) increased from 1,143 prescriptions in February 2020 to 75,569 in March 2020, an 80-fold increase from March 2019." * https://www.aljazeera.com/economy/2021/1/27/oklahoma-attempts-to-return-2m-worth-of-anti-malaria-drug https://www.aljazeera.com/economy/2021/1/27/oklahoma-attempt... "Oklahoma tries to return $2m worth of hydroxychloroquine" Under what circumstances does it work?

xapata 6y ago

> a real doctor, nurse practitioner, and the CDC Sadly, many doctors and nurses are statistically illiterate. I know, because I (try to) teach them statistics. Remember, the Surgeon General of the CDC said that, "[masks] are NOT effective in preventing general public from catching #Coronavirus," perhaps in some misguided belief that avoiding panicked mask-buying was more important than a mask-wearing public. [Sorry for insulting our healthcare heroes, but ... evidently y'all haven't been responsible for teaching them evidence-based medicine. It ain't easy.]

iso1631 6y ago
> The CDC was parroting the anti-mask blather of the Trump administration And the WHO were too?
- xapata 6y ago
  Sorry, edited after you wrote this. I took out the reference to the Trump administration because it wasn't helpful to the main point of many doctors not being experts on epidemics.
DanBC 6y ago
Can you link to the papers that were available in March 2020 that showed that masks are effective? Use any definition of "mask" and "effective" you want, but preferably effective should include some concept of "prevents spread of respiratory disease". Covid is a serious illness. Far too many people have been told, and believe, that they can continue their normal day to day life so long as they put mask on. This is untrue, and this advice has driven mass infection and death.
- TeMPOraL 6y ago
  This is a pandora's box. My recollection of the events is this: around March 2020, there were some links to somewhat shoddy studies of effectiveness of masks in case of other diseases, but the official statement was that masks were not proven to be effective - but that's because there was no randomized control trial performed to check mask effectiveness against SARS variants, and how could there be? This spins off into a whole discussion of how evidence-based medicine can lead you off the cliff when you follow its letter, and not spirit, because despite something being bloody obvious, there is no RCT proving that.

dmurray 6y ago

To be fair, professional medical advice was especially low-quality in the early days of the pandemic. What was important was public health messaging, picking some lowest-common-denominator messages and having everyone repeat them. It wasn't hard to be better informed than that.

phkahler 6y ago
>> To be fair, professional medical advice was especially low-quality in the early days of the pandemic. They primarily suffer from dogma IMHO. For example, now they know people with breathing difficulty should be kept in prone position. I dont know if that applies outside of Covid19, but I thought it was really interesting to see them learn it. Like "oh, what we'd normally do is bad but this variation is good". Medicine also suffers from a fear (justified) of litigation. If they dont follow accepted practices they may get sued if someone dies. The funny thing with Covid was watching that fear when there was no accepted treatment. Seeing them say "The FDA hasn't approved that for covid" when they hadn't approved anything at all yet.
- PaulDavisThe1st 6y ago
  > Medicine also suffers from a fear (justified) of litigation. very US-centric. Medical litigation in many others parts of the world doesn't work in the same way, and isn't a driving force in the way medicine is practiced.

hrktb 6y ago

I agree in principle. Then in real life example you will have real doctors and nurses giving conflicting advices and having wildly different viewpoints on the details. The easy to point to example is how a lot of doctors viewed masks at the beginning of the pandemic. Or how trickle down economics is also endorsed by experts. Or experts opinions on mental health drugs. And so many other subjects where it won’t be hard to find an expert on the dumb side of the argument. I think we should rely on experts, but we can’t dismiss people’s doubts or research just with a “I’ve seen a real doctor” slight of hand.

hef19898 6y ago
Conflicting doesn't mean that one, or both, opinions are wrong. There is more than solution to every problem.
scythe 6y ago
>Or how trickle down economics is also endorsed by experts. Trickle-down economics is not explicitly endorsed by anyone, because it's a pejorative. That's like saying "totalitarianism is popular in some countries"; you might think those countries are totalitarian, but they don't.
- PaulDavisThe1st 6y ago
  > you might think those countries are totalitarian, but they don't. "You" in the above is a specific individual. "They" in the above is undefined and extremely imprecise. For various definitions of "they", your statement could be true, false or somewhere in between.
- mjburgess 6y ago
  Indeed. Even then, as a term, it refers to a specific regan-era tax policy. What many on the left assume it means, is a sincere description of growth "raising the tide"; and how ridiculous an idea that is. Of course the tide has risen to an unprecedented degree in human history both since the term "trickle down" was invented; and moreso, over the last 40 years.

tacitusarc 6y ago

I absolutely agree with the main thrust of your comment, but I want to point out that in unprecedented times specifically, the odds that a smart non-expert is more correct than an expert are substantially higher than in normal times.

mcguire 6y ago
... but still not particularly high.

mcguire 6y ago

Engineers, in particular, have a reputation for being experts on everything.

glitchc 6y ago
perceived :D
- lioeters 6y ago
  I think "self-perceived expert" fits well. "When Knowledge Knows No Bounds: Self-Perceived Expertise Predicts Claims of Impossible Knowledge" - Stav Atir, Emily Rosenzweig, David Dunning https://journals.sagepub.com/doi/abs/10.1177/0956797615588195 https://journals.sagepub.com/doi/abs/10.1177/095679761558819...